Case Report Bullous Dermatosis in an End-Stage Renal Disease Patient: A Case Report and Literature Review Zeenat Yousuf Bhat, 1 Marwan Abu Minshar, 1 Nashat Imran, 1 Andrew Thompson, 2 and Yahya Osman Malik 1 1 Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University Detroit Medical Center, Detroit, MI, USA 2 Department of Pathology, Wayne State University Detroit Medical Center, Detroit, MI, USA Correspondence should be addressed to Zeenat Yousuf Bhat; zbhat@med.wayne.edu Received 1 August 2016; Revised 5 October 2016; Accepted 3 November 2016 Academic Editor: Władysław Sułowicz Copyright © 2016 Zeenat Yousuf Bhat et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Patients with advanced chronic kidney disease including ESRD patients may present with a wide spectrum of cutaneous abnormalities, ranging from xerosis to hyperpigmentation to severe deforming necrotizing lesions. Skin problems are not uncommon in this population of patients, with a clinical presentation that can be quite bizarre, mandating a long list of diferential diagnostic possibilities, and subsequent rise of a puzzling diagnostic challenge. We describe an ESRD patient who presented with blistering, nonhealing ulcerative lesions with a diagnostic skin biopsy revealing a mixed pattern of linear IgA bullous dermatosis and dermatitis herpetiformis. A clinical remission could be achieved with pulse intravenous steroids followed by oral maintenance in combination with dapsone, with no evidence of recurrence. 1. Case Presentation We report a 53-year-old African American male, who pre- sented with a 4-week history of gradually worsening painful itchy rash over the extremities and trunk, with subsequent development of blisters, bullae, and vesicles. He has been known to sufer from multiple comorbidities among which are end-stage renal disease (ESRD) presumed to be secondary to diabetic nephropathy (on maintenance hemodialysis since 2012), insulin-dependent diabetes mellitus, systemic hyper- tension, peripheral neuropathy in addition to advanced peripheral arterial disease (PAD), and chronic osteomyelitis for which he received local wound care. Tere is also a history of mucoepidermoid carcinoma of lef parotid gland (biopsy- proven) in the same year of starting dialysis. Tere were no new medications, including antibiotics that were prescribed over the three months preceding the presentation. Regular medications included aspirin 81 mgs daily, lisinopril 40 mgs, clopidogrel 75 mgs daily, atorvastatin 20 mgs at night, and calcium acetate 667 mgs three times a day with meals, in addition to IV erythropoietin 8800 units three times a week with dialysis, IV iron sucrose 50 mgs once a week, and IV calcitriol 1 mcg with each dialysis session. Physical examination revealed a thin malnourished gen- tleman weighing 67.8 kgs, bilateral below-knee amputee, pale, but not jaundiced or cyanosed, and in obvious dis- comfort but fully alert in time, place, and person with no myoclonus or asterixis. Vitals: temperature was 36.3 ∘ C, BP was 150/70 mmHg, respiratory rate was 18 per minute, and pulse rate was 84 per minute, thready and regular. Examination of the neck, heart, chest, and abdomen was essentially unremarkable, and clinically he was euvolemic. Peripheral arterial pulses were all absent, and no bruits could be heard over carotids, abdomen, or femoral; however, skin examination revealed extensive bullous lesions over the extremities extensor surfaces and trunk (Figure 1(a)). Many of these lesions had ruptured at diferent stages to give way to shallow ulcers with a necrotic base. His palm soles, oral cavity, and eyes revealed no evidence of lesions. Hindawi Publishing Corporation Case Reports in Nephrology Volume 2016, Article ID 6713807, 5 pages http://dx.doi.org/10.1155/2016/6713807